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Neurology 3A > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Signs of a non-epileptic seizure/Psychogenic non-epileptic seizure

A

Last longer, eyes are shut, Sinusoidal movements, Atonia, Post-ictal crying
Medically unexplained symptoms present
History of abuse (sexual)
EEG shows no ictal activity.
Refractory to normal drugs used in epilepsy
Common in females.

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2
Q

Definition of epilepsy

A

Tendency to experience recurrent and unprovoked epileptic seizures

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3
Q

Epileptic seizures

A

Paroxysmal, synchronous and excessive abnormal electrical activity in the brain causing symptoms such as disturbance of consciousness, behaviour, emotion, motor function, or sensation.

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4
Q

Status epilepticus

A

Prolonged convulsive or non-convulsive tonic clonic seizure lasting for 5 minutes or longer, or recurrent seizures (3 in 1 hr) with no regain in consciousness.

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5
Q

Types of partial seizures

A

Focal origin, 60% originate from temporal lobe.
Simple - no loss of consciousness.
Complex - impairment in consciousness.

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6
Q

Secondary generalised seizures

A

Initially partial seizure with focal origin which spreads to both cerebral hemispheres.

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7
Q

Generalised seizure and types

A

Initial bilateral involvement of both the cerebral hemispheres. Loss of consciousness.
Includes absence, tonic-clonic, myoclonic, atonic, infantile spasm.
Most occur after waking up.

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8
Q

Absence seizure

A

Staring vacantly.
Postural tone not impaired.
EEG= 3 per second spike-and-wave discharge.
In young children
Provoke with hyperventilation/blowing windmill in clinic.

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9
Q

Signs of a partial seizure in the TEMPORAL lobe

A

Aura of epigastric sensation, autonomic changes (flushing, BP), deja-vu, taste or olfactory hallucinations.
Motor arrest, lip smacking, chewing, dystonia.
Slow evolution over 1-2mins
Post-ictal confusion.

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10
Q

Signs of a partial seizure in the FRONTAL lobe

A 
Aburpt onset aura.
Vocal during seizure with cry.
Tonic spasms
Fencing posture
Pelvic thrust
Bring duration.
Rapid recovery
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11
Q

Generalised tonic-clonic seizure

A

Tonic = stiffness, clonic = jerk.
Sudden LOC and fall.
Initial tonic phase with high frequency and low amplitude of movements.
Clonic phase lasts longer than tonic phase.
Can loose bowl and bladder control.
Hard to rouse after, post-ictal confusion, headache, myalgia, retrograde amnesia.
Last 1-2mins

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12
Q

Myoclonic seizure

A

Abrupt, brief and sudden involuntary movements

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13
Q

Atonic Seizure

A

Sudden loss of muscle tone but not consciousness. Tonic = increase muscle tone so rigid they fall.

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14
Q

Causes and risk factors for epilepsy

A 
Genetic predisposition.
Neuro abnormalities.
Perinatal brain injury e.g. hypoxia
Febrile seizures in childhood
Intracranial infections, malignancies or surgery.
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15
Q

Differential diagnosis of epileptic seizure

A 
Syncope
Cardiac arrythmia
Panic attack + hyperventilation
Non-epileptic seizure 
Hypoglycaemia
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16
Q

Signs of syncope

A

Transient acute LOC and loss of postural tone due to reduced cerebral perfusion.
Provoked by pain, prolonged standing and postural change.
‘Aura’ of feeling faint, right headed, blurred vision.
Skin change to pale
No incontinence, tongue biting or ‘post ictal’ confusion.

17
Q

Managing suspected/diagnosed epilepsy

A
  • Refer to specialist to confirm a diagnosis, in this time advise against driving, swimming and dangerous leisure activities. Give carer info on when to recognise a seizure and if possible video and document it.
  • Consider trial of anti-epileptic
  • Once diagnosed patient needs to tell DVLA and can’t drive until 1yr seizure free.
18
Q

Name 4 Antiepileptic drugs

A

Carbamazepine
Lamotrigine
Sodium Valproate
Phenytoin

19
Q

Management of an epileptic seizure

A

Do not restrain
Protect them from injury with with cushions and removal of harmful nearby objects.
When seizure ceased assess airway and potential injuries.
Watch and treat as status epileptics if appropriate (last longer than 5mins or more than 3 in hour)

20
Q

Management of status epileptics

A

1) Buccal midazolam (First line treatment in community/prehospital). Alternative = rectal diazepam.
2) In hospital A-E resuscitation (oxygen, BM, secure airway, IV access) and IV lorazepam.
3) IV phenytoin.
4) RSI and anaesthetic aid.
Blood investigations if poss (U&E, LFT, FBC, glucose)
Give oxygen

21
Q

EEG

A

Not diagnostic!

Spike then slow wave pattern

22
Q

Drug withdrawal

A

If over 2yrs symptom free consider withdrawal

23
Q

Causes of a non-epileptic seizure

A

hypoxia, alcohol, drugs (cocaine, tricyclics), head trauma, cerebrovascular pathology (haemorrhage)

24
Q

Trigges of an epileptic seizure

A

Flickering lights, sleep deprivation, alcohol, stress, caffeine.

25
Q

Classic pattern on EEG for epilepsy

A

Spike followed by slow wave discharge.

26
Q

Todd’s paresis

A

Transient paralysis after a seizure/post-ictal.

27
Q

Diseases which predispose to cardiac syncope and when do they become apparent

A 
Arrhythmia e.g. Wolff-Parkinson-White
Heart blocks e.g. Complete 3rd degree blocks
Cardiac ischaemia
Structural heart defect.
Blackout during exercise commonly.
28
Q

Neurally mediated syncope

A

Vasovagal. Due to prolonged standing, sudden fear, heat, severe pain.

29
Q

Investigating possible epilepsy/seizure

A 
Bloods - U+E, BM, metabolic profile (calcium), FBC, serum creatinine kinase.
Toxin and drug screen.
ECG!!!
LP?
EEG to support not diagnostic.
Brain imaging via CT or MRI.
30
Q

1 st line drug choices for generalised Tonic clonic

A

Sodium valproate or lamotrigine

31
Q

1st line drug choices for absence seizure

A

Sodium valproate, ethosuximide, lamotrigine as adjuvant.

32
Q

1st line drug choice for tonic or atonic

A

Sodium valproate (not lamotrigine!) or topiramate

33
Q

1st line drug choice for focal partial seizure +/- generalised

A

Carbamazepine

34
Q

1st line drug treatment for infantile spasm/Wests

A

Prednisolone, vigabatrin

35
Q

1st line drug treatment for juvenile myoclonic seizures

A

Sodium valproate.

36
Q

Some side effects of valproate

A 
Reversible hair loss
Teratogenic!
Weight gain
Thrombocytopenia
Liver failure
Oedema
37
Q

Some side effects of lamotrigine

A

Rash, blurred vision, vomiting, tremor

38
Q

Some side effects of carbamazepine

A 
Diplopia
Leucopenia
Drowsy
Rash
Dizzy
39
Q

1st line drug choice for myoclonic seizure

A

Sodium valproate or topiramate, (not lamotrigine)

Neurology 3A (7 decks)

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